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M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OVYNER BUILI'ER I'EICARATION <br />I lrcby alfrn undc paratty of pcrjury tha I m qmF fDm thc Contr.cloB' Licalc kw for thc following wn (Soc.7031.5 <br />Buins and hofeioo Codc): Any City or Counry which rcquire a pcmit to @nstBct. dts. improvc, &trolbh or rcpat ey <br />structuqprbrtoits iswcc,alsorcquirothcapplicutforsuchp<mittofilcaaigncdstatm@t thahcorshcblicoscd puman <br />to thc prcvisioro of thc Contractor'! Lienlcd Law (Chapt6 9, Commmcing with Sction 7000 of Division 3 of thc Buine md <br />Prcfeiom Codc) or thrt hc or shc b qmpt thqciom ed thc bais for thc allcgcd amption. Any violatioo of Sction 703 1.5 by my <br />applicmt for a pcrmit subjcr thc pplicmt to E civil pmlty of not morc the fivc hudrcd dollm ($500). <br />_I. u ma of thc prcpoty. or my coploy€ with wag€ I thcir olc ompasaion will do tlE wort ed thc stucrw b mt <br />intqrdcd or offcrcd for slc (Sc.?044. BBiB ud Profeior Codc: Thc Conlnctq'r Lic@ trw do6 rct apply to e ow of <br />thc propqty who hrildr or imForc thaoq ad who &c $crh wtt himclf or hgslf or thrcugh his or h6 om oployccs. <br />providcd that such imFomts e mt intadrd or offrcd for slc. l[ how, thc tuiHing or improwt fu eb within onc ]€r <br />ofcompldioD, thc Own6 Buikk will haw thc h[da ofproving tha hc or shc dkl not buiE or inprovc thc propdty &r thc purporc of <br />slc). <br />-1. <br />as owner of the propcrty, am exclusively contracting with licerued contractors to construct the project (Sec. 7M4. Bwiness <br />and hof€ssbn Code: The Contractor's License Law does not apply to an own€r of property who builds or improves thercon, <br />and who contracts for such projects with a Contraaor(s) ticensed puniuant to the Contractor's License law). <br />_l am B.&re99!l.._ <br />I hereby affrrm under pcnalty of perjury one of the following <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, as providd for by Scction 3700 of the <br />Labor Code for the performance of the work for which the permit is issued. <br />-l <br />have and will maintain workers' comperuiation insurance. as requird by Section 3700 of the Labor Code, for the pcrformance of <br />the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: <br />Policv Number: Exoircs: <br />-l <br />certi& that in the performance of the work for which this perrnit is issued. I shall not employ any person in any manner <br />so asi to become subject to the work€rs' compensation laws of California, and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code. I shall. forrhwith comply with those provisions.. <br />WARNING: Failure to secure workers' compensation cot'erag,e is unlawful. and shall subject an onployer to crirninal parahies and <br />in addition to the of compcnsation. damages as provided ltr the <br />Section 3076 of the lJbor Code. r$teresl <br />,rr", q /lf lq and <br />/ ( -l / <br />I hereby affirm under penalty of perjury that <br />LTCENSEDCONTRACTOR <br />--. <br />ng.l q, rt <br />I am licensed under provision of Chapter 9 (commcncing with Secrion 7000) of Division 3 <br />of the Business and Professions Code. and my liccnse is in full force and effect. <br />License Class: License Number: <br />CONSTRUCTION T -TiTDING ACENCY <br />I hacby affm unda Fulty of pajury thd th@ b E @ndructiu landirg agocy for thc pqbmcc of thc wk for which thb psmit b <br />ilsucd (56. 3097. Civ. C.). <br />Lender's Address: - ,pI tc N" "FC, <br />. R T <br />I hereb}, affirm under penalty of perjury one of the following declarations: <br />Demolition Pcrmits-Asbcstos Notification Federal Regulations (Title 40. Part6) <br />-Required <br />Letter of Notification <br />-l <br />certi! that the federalregulations regarding asbestos removalarc nol applicable to this project. <br />-l <br />certify that I have read this application with all City and County <br />and County to ent€r upon theordinances and State laws relating <br />above mextiond property for <br />( <br />Applicant or Agent <br />Permitee name <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />I I <br />Roush Mech. /0/ t / lq ru{z /r <br />Final Test <br />Meter Release I €*) <br />FINAL Itgl/*l A'Y <br />Notes, Remarks, Etc.rf t <br />l)atlr-)ar- <br />hundred thousand <br />Lender's Name:/ <br />-ltq -^ r t.*9., <br />U